Affinity Health Plan

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  • Compliance and Regulatory Affairs

    The Compliance and Regulatory Affairs department is responsible for organizational compliance with applicable laws, rules, regulations, and contractual requirements for all lines of Affinity's business.  The Compliance and Regulatory Affairs function is an enterprise-wide service that ensures that Affinity, its Board of Directors, employees, and business partners, conduct business activities in an ethical, professional, and legal manner.

    The department has three units: Corporate Compliance, Medicare Compliance, and Regulatory & Legal Affairs.

    Corporate Compliance
    » Maintains the Corporate Compliance program and Code of Ethics
    » Protects Affinity's integrity and financial resources from fraudulent, wasteful, and abusive activity by identifying, investigating, and resolving instances of healthcare fraud as well as compliance-related allegations

    » Identifies and assesses risks to the enterprise and works to control, monitor, and mitigate future activity

    » Develops and organizes corporate-wide training programs for compliance-related activities

    Medicare Compliance
    » Monitors and ensures timely communication to all areas of the organization regarding the Medicare program
    » Reviews and disseminates CMS information assuring that the appropriate actions are taken
    » Reviews the status of the corrective action plans and assures timely reporting to CMS
    » Directs all activities regarding Medicare appeals and grievances

    Regulatory & Legal Affairs
    » Serves as Affinity's main liaison with State agencies and local districts
    » Tracks impact of the regulatory mandates and assures implementation in the operational areas
    » Assists with the development of lobbying strategy and health policy analysis
    » Provide advice and counsel on all legal matters including subpoenas, litigation, or other risk areas